THIS SECTION IS FOR HEALTHCARE PROFESSIONALS (HCPs) ONLY
If you’re a patient and would like to apply for coverage, please check your eligibility.
If you qualify, please contact your HCP, who must apply on your behalf.
Learn more about the application process.
OPAF Care Connect
If you’re an HCP, you can use the Otsuka Patient Assistance Foundation, Inc. (OPAF) portal on behalf of your patients to submit and track applications, download forms, access patient information, and more. Plus, the portal offers the fastest patient application processing time — you’ll receive your patient’s eligibility determination within 48 hours once all documentation has been submitted. If you do not have access to the portal, you can download the paper application below.
Enrollment Application for
Enrollment Application for
Enrollment Application for REXULTI® (brexpiprazole) tablets
Enrollment Application for NUEDEXTA® (dextromethorphan HBr and quinidine sulfate) capsules
Enrollment Application for SAMSCA® (tolvaptan) tablets
Enrollment Application for JYNARQUE® (tolvaptan) tablets
See U.S. FULL PRESCRIBING INFORMATION for NUEDEXTA.
See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING for
See MEDICATION GUIDES for
Apply online for your patients
Submit and manage your patient applications
from start to finish:
Receive eligibility determination
within 2 business days
Use your work space to find
patient
applications, consent
forms and
documents
Email patient eConsent and HCP
eSignature for a seamless
application process
Store individual prescriber
information and patient prescription
details for quick product orders
Find documents
quickly
and easily
Access relevant patient documentation and treatment information in a secure, online location:
- Search for patient information quickly with My Case Search
- Initiate annual applications from existing patient case information
- Store patient eConsent forms for future assistance applications
Get up-to-date and
timely notifications
Stay informed with email notifications for patient applications and product requests:
- Get updates regarding your patient application status and determination results
- Receive notifications when it’s time for annual patient reapplications
- Track status of product shipments
Register your
patient today
Prefer to fax in an application for your patient? Just follow these 3 simple steps:
- Download and print the application
- Collect all required documentation from your patient
- Fax the application and the documentation to OPAF at 1-844-727-6274
Please note: Faxed applications are processed within 5 business days. If this is a time-sensitive
request, please submit an application online.
Enrollment Application for
Enrollment Application for
Enrollment Application for REXULTI® (brexpiprazole) tablets
Enrollment Application for NUEDEXTA® (dextromethorphan HBr and quinidine sulfate) capsules
Enrollment Application for SAMSCA® (tolvaptan) tablets
Enrollment Application for JYNARQUE® (tolvaptan) tablets
See U.S. FULL PRESCRIBING INFORMATION for NUEDEXTA.
See U.S. FULL PRESCRIBING INFORMATION, including BOXED WARNING for
See MEDICATION GUIDES for
To help expedite your patient’s application, be sure to include the proper documentation with your fax, including:
- Proof of income
- Proof of US Address
